Trends in Alcohol-Induced Deaths in the United States, 2000-2016
Trends in Alcohol-Induced Deaths in the United States, 2000-2016
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DOI：
10.1001/jamanetworkopen.2019.21451
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发表时间：
2020-02-21
影响因子：
13.8
通讯作者：
Freedman, Neal D.
中科院分区：
文献类型：
--
作者：
Spillane, Susan;Shiels, Meredith S.;Freedman, Neal D.
在过去的20年里，美国因酒精引起的死亡率显著增加。然而，缺乏对性别、年龄、种族/民族以及社会和地理因素对酒精导致的死亡率趋势的综合评估。目的研究2000年至2016年酒精导致的死亡率趋势，比较包括性别、种族/民族、年龄、县级社会经济地位和地理位置在内的人口统计学特征的结果。这项连续横断面研究使用了2000年至2016年美国所有15岁以上居民的国家生命统计数据。数据分析时间为2019年1月至9月。按性别、种族、年龄、县级社会经济地位（即收入中位数、失业居民百分比、拥有学士学位的居民百分比）、乡村水平和美国州划分的酒精导致的死亡率趋势。主要结果和测量酒精导致的死亡率，即酒精占人口比例1的死亡率。每10万居民的死亡率以绝对死亡率和年龄标准化死亡率表示。死亡率趋势以整个时期的平均年百分比变化（AAPC）来衡量（即2000-2016年）和研究期间各个变化期的年百分比变化（APC）。结果2000 - 2016年，共确定了425045例酒精引起的死亡（2000年：19 627例死亡; 14 979例[76.3%]男性; 2016年：34 857例死亡; 25 213例[73.3%]男性）。男性因酒精导致的死亡率大幅上升（AAPC，1.4%; 95% CI，1.0%-1.8%）和女性（AAPC，3.1%; 95% CI，2.6%至3.6%），最近加速（男性，2012-2016年：APC，4.2%; 95% CI，3.1%至5.3%;女性，2013-2016年：APC，7.1%; 95% CI，5.1%至9.1%）。按人种/种族列出的最大增幅见于美洲印第安人和阿拉斯加原住民男性（AAPC，3.3%; 95% CI，2.6%-4.0%）、美洲印第安人和阿拉斯加原住民女性（AAPC，4.2%; 95% CI，3.8%-4.6%）和白色女性（AAPC，4.1%; 95% CI，3.6%-4.7%）。尽管黑人女性、黑人男性和拉丁裔男性的比例最初有所下降，（例如，拉丁裔男性，2000-2003年：APC，-5.1%; 95% CI，-9.8%至0.1%; 2003-2013年：APC，-0.6%; 95% CI，-1.4%至0.2%），增加发生在研究期后期（例如，拉丁裔男性，2013-2016年：APC，4.1%; 95% CI，0.3%-8.1%）。增长率因年龄组和种族/族裔组而异。在白色个体中，中年时绝对值大幅增加（例如，55-59岁的男性，2000-2003年：每10万居民死亡25.5人; 2013-2016年：每10万居民死亡43.3人; 50-54岁的女性，2000-2003年：每10万居民死亡7.4人; 2013-2016年：每10万居民中有16.5人死亡），尽管25至34岁的APC也很大，男性每年从4.6%至6.9%不等，女性从7.3%至12.0%不等。在美洲印第安人和阿拉斯加原住民中，观察到整个年龄段的增加，其中45至49岁男性的绝对增加最大（2000-2013年：每10万居民113.6人死亡; 2013-2016年：每10万居民193.1人死亡）和50至54岁妇女（2000-2013年：每10万居民中有56.1人死亡; 2013-2016年：每10万居民中有105.1人死亡）结论和相关性这项研究发现，在美国人口的各个年龄和种族/民族亚组中，酒精导致的死亡率大幅增加，近年来这种情况有所加速。年轻群体中酒精所致死亡的大幅增加可能与未来酒精相关疾病的增加有关。
Importance Notable increases in mortality from alcohol-induced causes over the past 2 decades in the United States have been reported. However, comprehensive assessments of trends in alcohol-induced mortality by sex, age, race/ethnicity, and social and geographic factors are lacking.Objective To examine trends in alcohol-induced mortality rates from 2000 to 2016, comparing results by demographic characteristics including sex, race/ethnicity, age, county-level socioeconomic status, and geographic location.Design, Setting, and Participants This serial cross-sectional study used US national vital statistics data for years 2000 to 2016 for all US residents older than 15 years. Data analysis was conducted from January to September 2019.Exposures Trends in alcohol-induced mortality by sex, race/ethnicity, age, county-level socioeconomic status (ie, median income, percentage of unemployed residents, percentage of residents with a bachelor's degree), rurality level, and US state.Main Outcomes and Measures Alcohol-induced mortality, ie, deaths for which alcohol holds a population-attributable fraction of 1. Deaths were expressed per 100 000 residents as absolute and age-standardized rates. Mortality trends were measured as average annual percentage changes (AAPCs) for the entire period (ie, 2000-2016) and annual percentage changes (APCs) for individual periods of change within the study period.Results A total of 425 045 alcohol-induced deaths were identified from 2000 to 2016 (2000: 19 627 deaths; 14 979 [76.3%] men; 2016: 34 857 deaths; 25 213 [73.3%] men). The rate of alcohol-induced deaths increased substantially among men (AAPC, 1.4%; 95% CI, 1.0% to 1.8%) and women (AAPC, 3.1%; 95% CI, 2.6% to 3.6%) and accelerated recently (men, 2012-2016: APC, 4.2%; 95% CI, 3.1% to 5.3%; women, 2013-2016: APC, 7.1%; 95% CI, 5.1% to 9.1%). The largest increases by race/ethnicity were observed among American Indian and Alaska Native men (AAPC, 3.3%; 95% CI, 2.6% to 4.0%), American Indian and Alaska Native women (AAPC, 4.2%; 95% CI, 3.8% to 4.6%), and white women (AAPC, 4.1%; 95% CI, 3.6% to 4.7%). Despite initial declines among black women, black men, and Latino men (eg, Latino men, 2000-2003: APC, -5.1%; 95% CI, -9.8% to -0.1%; 2003-2013: APC, -0.6%; 95% CI, -1.4% to 0.2%), increases occurred later in the study period (eg, Latino men, 2013-2016: APC, 4.1%; 95% CI, 0.3% to 8.1%). The rates of increase varied by age group and in turn by racial/ethnic group. Among white individuals, large absolute increases occurred in midlife (eg, men aged 55-59 years, 2000-2003: 25.5 deaths per 100 000 residents; 2013-2016: 43.3 deaths per 100 000 residents; women aged 50-54 years, 2000-2003: 7.4 deaths per 100 000 residents; 2013-2016: 16.5 deaths per 100 000 residents), although APCs were also large for ages 25 to 34 years, ranging from 4.6% to 6.9% per year among men and from 7.3% to 12.0% among women. Among American Indian and Alaska Native individuals, increases throughout the age range were observed, with the largest absolute increase occurring for ages 45 to 49 years among men (2000-2013: 113.6 deaths per 100 000 residents; 2013-2016: 193.1 deaths per 100 000 residents) and for ages 50 to 54 among women (2000-2013: from 56.1 deaths per 100 000 residents; 2013-2016: 105.1 deaths per 100 000 residents).Conclusions and Relevance This study found large increases in alcohol-induced death rates across age and racial/ethnic subgroups of the US population, which have accelerated over recent years. Large increases in alcohol-induced deaths among younger age groups may be associated with future increases in alcohol-related disease.